Case Management Coordinator

Healthcare Consultant I

Our client, a Retail Pharmacy company, is looking for a Healthcare Consultant I for their Mid Miami location. Must be in one of these zip codes: 33174, 33144, 33134, 33165, 33175, 33184, 33182, 33172, 33126.

Responsibilities:

• Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
• Conducts comprehensive evaluation of Members using care management tools and information/data review
• Coordinates and implements assigned care plan activities and monitors care plan progress
• Conducts multidisciplinary review to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Helps member actively and knowledgeably participate with their provider in healthcare decisionmaking, monitoring, evaluation and documentation of care.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.

Requirements:

• One year Case management experience A MUST
• Case Management Certificate (Preferred)
• Long term care experience (Preferred)
• Microsoft Office including Excel competent
• Ability to multitask, prioritize and effectively adapt to a fastpaced changing environment
• Effective communication skills, both verbal and written
• Managed Care experience
• Computer proficiency in Microsoft Word, Excel, and Outlook required
• Case management and discharge planning experience
• Bachelor's degree required No nurses.
• Social work degree or related field preferred.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities